Provider Demographics
NPI:1205374485
Name:AETNA BETTER HEALTH OF NEVADA INC.
Entity Type:Organization
Organization Name:AETNA BETTER HEALTH OF NEVADA INC.
Other - Org Name:AETNA BETTER HEALTH OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP, MEDICAID
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-659-1160
Mailing Address - Street 1:4500 E COTTON CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 E COTTON CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8840
Practice Address - Country:US
Practice Address - Phone:602-659-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AETNA HEALTH HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161477081302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization